Imaging Use, ED Visits Higher Among Self-Neglect Mandate Patients

“Older adult self-neglect is a critical, yet under-recognized public health issue,” Dr. Duraisamy said. “This retrospective study is one of the first to systematically evaluate the imaging patterns and health outcomes of older adults who have been flagged for self-neglect in the ED using a case-control analysis.”

The research team evaluated imaging patterns and outcomes in two groups of older patients (age 60 or older) over a four-year period. All patients presented to the ED at Brigham and Women’s Hospital or Massachusetts General Hospital.

The case group included 111 patients who received a self-neglect mandate during their visit. These patients were compared to age, gender and race-matched controls who visited the ED the same year. The median age of the subjects was 78 and the study group was predominantly white.

“ED staff are mandated to report suspected self-neglect cases, including inadequate nutrition, poor hygiene, medication non-compliance and a lack of shelter,” Dr. Duraisamy said. “Once reported, the local elder protective services agency typically investigates and develops a plan to address the patient’s needs, which the individual can accept or deny.”

The researchers collected data on imaging utilization, including CT, MRI, US and X-rays, as well as demographic data, housing type, insurance, substance use and mental health disorders.

Compared to the control group, the self-neglect group had twice as many ED revisits and nearly three times as many hospital readmissions. The case group also had 1.5 times greater imaging utilization on the first ED visit, which increased to nearly twice as much during subsequent visits. Rates of pneumonia and mortality were eight and nine times greater in the self-neglect group compared to controls.

Patients who followed recommendations had fewer ED revisits than those who were non-compliant. The non-compliant group had a 2.5 higher death rate compared to patients who followed recommendations. 

“The self-neglect group showed significantly higher healthcare utilization including twice as many ED visits, three times as many hospitalizations and nine times more mortality,” Dr. Duraisamy said.
According to Dr. Duraisamy, identifying at-risk patients and employing early intervention strategies can support this vulnerable population and decrease the strain on the already overwhelmed health care system.

“Addressing the issue of older adult self-neglect requires a multifaceted approach that involves education, early detection and intervention,” Dr. Duraisamy said. “At TIRIC, we are integrating multiple data sources to develop an AI model to help predict which patients may be at risk for self-neglect.”

Bharti Khurana, MD, MBA, principal investigator and TIRIC founder and director, said her team is systematically reviewing chart notes and imaging reports on a large cohort of patients prior to receiving a self-neglect mandate and during subsequent follow-up. 

“Our ultimate goal is to identify these patients early so they don’t get to a self-neglect mandate, and we can eliminate the downstream effects,” said Dr. Khurana.

Access the presentation, “Imaging Utilization of Self-Neglect Mandate Patients in the Emergency Room,” (T3-SSER01-1) on demand at RSNA.org/MeetingCentral